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PubMed1999

British Isles symposium on the future of dental clinical skills training.

A symposium on the future of dental clinical skills training is reported. Abstracts of the symposium presentations review the current and future use of simulation in dental education, future skills training in the creation of new dentists, equipment and methods for simulation, the transition from simulation to clinical practice and recent developments in simulation employing new technologies. The report concludes that simulation will continue to have an important, probably increasing role in dental education, and that further developments in clinical skills training should be sensitive to changing patterns of dental disease and opportunities of provide clinical instruction.

Clinical Competence↗
PubMed1999

Using Medicaid claims to construct dental service market areas.

OBJECTIVE: To use Medicaid claims data to construct patient origin-based market areas for dental services and compare constructed market areas with those based on the practice county. DATA SOURCES: North Carolina Medicaid claims, eligibility, and provider files, the Cooperative Health Information Systems' dentist licensure files, and the Log Into North Carolina data. STUDY DESIGN: A visit-level file was created from the Medicaid claims data and aggregated by provider practice county and patient county of residence. Using the aggregated file and an algorithm based on the Elzinga-Hogarty approach, patient travel patterns were used to construct mutually exclusive patient origin market areas. DATA ANALYSIS: Market area characteristics were compared across definitions using Pearson correlation coefficients. In addition, estimations of provider participation were performed using market area characteristics as control variables. The beta coefficients associated with market area characteristics were compared across market area definitions. PRINCIPAL FINDINGS: Medicaid claims data, when combined with provider licensure files, can be used to construct market areas based on patient origin data. However, measures of market area characteristics are correlated highly between the two types of market areas studied. Furthermore, beta coefficients on market area variables in models of provider participation are similar in sign, significance, and magnitude across market definitions. CONCLUSIONS: Compared with market areas constructed using patient origin data, county-based market areas adequately proxy for dental markets. Using the county as the market area also avoids the time and computational costs associated with using a patient origin-based approach and facilitates the use of widely available data.

Catchment Area, Health↗
PubMed2005

Women in dentistry in South Africa: a survey of their experiences and opinions.

Women form an increasingly important part of the dentally trained workforce in South Africa. However, little is known about the professional issues and work-related problems affecting women dentists. A postal survey was undertaken of registered female dental practitioners in the country, with the aim to document their experiences. The survey (i) ascertained their current pattern of work, (ii) identified factors influencing their work patterns and (iii) identified factors that would help women remain in the profession or re-enter it more easily after an absence. A self-administered 50-item questionnaire containing open and closed-ended questions was used. Questions related to professional status, working patterns, practice ownership, postgraduate qualifications and career satisfaction. Nine hundred and sixty questionnaires were sent out and 280 were returned (29% response rate). Although a significant majority were currently practicing (96%), about 20% were employed or worked part-time and 7 reported that they were not in practice at the time of the survey for various reasons including maternity leave, ill-health, retirement or that they were now working outside the dental field. Major factors identified in this study were the women's dual responsibility at home and at work. Few women find themselves in specialist practice, although 68% indicated that they would liked to have specialised. Home responsibilities and inflexible working conditions were commonly reported difficulties experienced with further studies. In addition, the lack of part-time training and the geographical location of training facilities also played a role. Women dentists need more flexible working schedules and conditions of employment. Part-time training and part-time career options should be extended. Retraining and refresher courses for Women dentists who have had a break in their careers should be available to enable them to return sooner and more easily to practice. Tertiary training dental facilities throughout the country should take up this challenge and run courses that are tailored to the local need and domestic commitments of the women involved.

Adult↗
PubMed1993

Ontario dentists: 1. Radiologic practices and opinions.

In February 1991, about 10 per cent of Ontario's general dentists were polled via a mail survey to gather information about their radiological practices and opinions. Responses were received from 413 out of 537 general practitioners, for a response rate of 77 per cent. A large majority of dentists (86 per cent) have no written office policy and/or protocol for selecting patients for X-ray examination, and just over half (54 per cent) primarily use clinical experience to select patients for these examinations. In the majority of practices (57 per cent), radiographs of asymptomatic recall patients are taken after both their history and clinical examination are complete. A similar percentage (56 per cent) of dentists are opposed to explicit guidelines for radiological examinations.

Dental Caries↗
PubMed1994

Service-mix provided to patients in Australian private practice.

Service-mix can reflect changes in demographic factors, oral health, patient demand and treatment philosophies. The aim of this study was to compare service-mix by patient age in 1988 with baseline data from 1983. A weighted, stratified random sample of dentists in Australia was surveyed by mailed questionnaire in 1983 and again in 1988. Service-mix was dominated by restorative, diagnostic and preventive areas. Comparing 1988 with 1983, there were significant increases for diagnostic, preventive, advanced restorative, orthodontic and general areas. Patterns across patient age groups and between years indicated younger patients were being provided with increased preventive services (patients aged 5-11, 25-44 years) and decreased restorative services (patients aged 5-11, 12-17 years), while older patients were being provided with reduced prosthodontic services (patients aged 25-44, 45-64 years), but increased restorative services (patients aged 45-64, 65+ years) and advanced restorative services (patients aged 25-44, 45-64 years). These patterns of service-mix have implications for dental education, research and service delivery.

Adolescent↗
PubMed1975

Dental care of the special patient in the hospital environment.

In this new era, where the emphasis in dental care is gradually moving in the direction of the patient, as differentiated from the former emphasis on the teeth and the mouth, the 'special patient' can and should receive the type of total dental care he or she deserves. The environment of the hospital, and all that the hospital brings with it to the patient care environment, makes the facilities for special patient care better and allows patients who were formerly seriously neglected to receive much the same attention as so-called normal patients. The group of special patients considered includes the physically handicapped, institutionalized or home-bound chronically ill, those with psychiatric disturbances and the mentally retarded as well as the hospitalized patient. One example of a hospital dental service conducted as a group practice is described in some detail. Advantages of this pattern of practice to the participants include the availability of conferences and clinics, access to a broad range of patient experience and the possibility of further study in specialized hospital activities. For the patient, total dental care is available throughout the 24 hours. Each patient is normally assigned to his or her own dentist, but is referred to another member of the group when special skills are needed.

Dental Service, Hospital↗
PubMed1994

A study of the dietary fluoride supplementation prescribing pattern of south Glamorgan dentists.

Following the inclusion of dietary fluoride supplements in the Dental Practitioners Formulary on 1st January 1993, the aims of this study were to observe the fluoride supplementation prescribing pattern of South Glamorgan general dental practitioners and relate it to the latest caries prevalence data. The analysis was carried out on the prescribers and recipients of the prescriptions using post codes to locate all members of both groups into one of 26 dental planning areas (DPA) within the district. As the age of a minority of recipients could not be substantiated, an assumption that they were all 14 years or under was used to calculate a prescription to population ratio for each DPA. These ratios were correlated against the latest available caries prevalence data for each DPA to ascertain any relationship between the level of fluoride supplement prescription and the caries prevalence within South Glamorgan. Data were collected via the Prescription Pricing Division of Welsh Health Common Services Authority for the six month period, 1st January to 30th June 1993. Of 623 prescriptions dispensed within South Glamorgan, 581 were issued by dentists working in the District for patients living in the District. Of the 163 dentists registered within South Glamorgan FHSA, (boundary coterminous with the DHA) 49 made one or more prescription. Of these, 10 dentists wrote 20 prescriptions or more, totalling 401, during the study period, i.e. 6 per cent of the dentists made 69 per cent of the prescriptions. The correlation of the number of prescriptions issued per DPA (according to the dentists' location) with whole time equivalents in that DPA was 0.58 (P < 0.002).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Maxillectomy--to reconstruct or obturate? Results of a UK survey of oral and maxillofacial surgeons.

Post-maxillectomy defects may be restored either by surgical reconstruction or by prostheses and there is continuing controversy about the most appropriate method of rehabilitation in any particular case. A questionnaire was designed to assess the current practices of oral and maxillofacial surgeons in the UK after resection of the maxilla for malignant disease. Maxillectomies were carried out by 83% of surgeons; most surgeons do 1-5 cases a year; 38% of surgeons do reconstruct surgically, but only in 10% of cases. Only 65% of surgeons have access to the services of a restorative dentist; this did influence 19% of surgeons' decision about whether to reconstruct surgically or restore by prosthetic means.

Humans↗
PubMed2003

The workforce of professionals complementary to dentistry in the general dental services: a survey of general dental practices in the South West.

OBJECTIVE: To describe the working patterns, training experiences, estimated size, and future training needs of the workforce of professionals complementary to dentistry in the general dental service in an English region. METHODS: Postal questionnaire of NHS dental practices in the South West of England. RESULTS: The response rate was 65%. There was an average of two whole time equivalent (wte) dentists working per practice. Dentists work a mean 0.8 wte per practice. Sixty per cent of practice time is NHS. Vacancies existed for 120 dentists (98 wte) with reported difficulties in recruitment. There was an average of 1.25 wte dental nurses per dentist with 44% of nurses working part-time. A quarter of nurses' time is on non-clinical duties. The turnover rate for nurses was between 13% and 26%, with recruitment difficulties. Approximately 50% of nurses do not have a professional qualification. There is variation between health authorities in proportions of qualified nurses. Hygienists are employed in 72% of practices, but only 20% of their work is NHS. Dentists have favourable attitudes to an expansion in the employment and training of professionals complementary to dentistry. CONCLUSIONS: There are problems with recruitment and retention of all categories of the dental workforce in the GDS, particularly in rural areas. There is a large unmet need for pre- and post-qualification training for professionals complementary to dentistry compounded by marked inequalities in access to training.

Administrative Personnel↗
PubMed1999

Prevalence and attitudes to fissure sealants in the general dental service in England.

OBJECTIVES: The study objectives were to investigate changes in the prevalence of fissure sealants over a 5-year period among a comparable group of 14-15-year-old regular dental attenders registered with general dental practitioners in 1989 and 1994, and to investigate attitudes towards this form of care amongst general dental practitioners in 1994. METHODS: Random samples of 14-15-year-old pupils were selected from school lists in three areas in England (Doncaster, Hereford/Worcester and Wycombe) in 1989 and 1994. Once parental consent had been gained to examine the children, the Dental Practice Board (DPB) indicated which subjects were 'regular attenders', only these subjects were included in the study. All the subjects in each area were examined by a single trained and calibrated examiner using a standardized technique. In 1994, a group of randomly selected dentists in each area completed a telephone questionnaire assessing attitudes and treatment patterns regarding fissure sealants. RESULTS: In 1989, 2836 letters were posted to parents asking for consent to examine their child and 2174 positive responses were received (response rate 77%). Of the 1919 children examined, 459 were classed as regular attenders, 140 in Doncaster, 159 in Hereford/Worcester and 160 in Wycombe. In 1994, 2560 consent letters were distributed to children in school to pass to their parents and 1587 positive responses were received (response rate 62%). Of the 1388 children examined, 891 were classed as regular attenders, 294 in Doncaster, 318 in Hereford/Worcester and 279 in Wycombe. Large rises in sealant prevalence were observed in all areas, but particularly in Doncaster where sealant prevalence increased from 13% in 1989 to 50% in 1994. In Hereford/Worcester it increased from 25% to 47% and in Wycombe it increased from 16% to 30%. There was also a fall in mean DMFT in all areas. In Doncaster it fell from 2.97 in 1989 to 1.82 in 1994, in Hereford/Worcester it fell from 2.60 to 1.83 and in Wycombe it fell from 1.86 to 1.29. In all three areas the changes in sealant prevalence and DMFT were statistically significant. The questionnaire revealed positive attitudes towards fissure sealants and their usage as well as a number of areas of concern that could potentially hinder sealant usage. CONCLUSIONS: Dramatic increases in sealant prevalence and considerable reductions in dental caries among these regularly attending adolescents have been demonstrated. Some concerns were highlighted regarding sealant usage, which may be prejudicing further increases in their application.

Adolescent↗
PubMed2003

Comparison of restorative dentistry referrals to a district general hospital and to a teaching hospital using a pilot Index of Restorative Dental Treatment Need.

The purpose of this study was to identify differences between referral patterns and the clinical conditions of patients referred to consultant-led Restorative Dentistry clinics in a district general hospital and a London dental teaching hospital. The Index of Restorative Dental Treatment Need was used to classify patients into those patients whose treatment was appropriate for any dental graduate in general practice, for an experienced dentist in general practice, and for a dentist with specialist training. Demographic and clinical details were recorded for one hundred patients at each hospital. The results of the study showed that the proposed treatment of 21% of the patients seen at the district general hospital and 16% of the patients seen at the teaching hospital was appropriate for specialist care. The results support the expansion of specialist restorative dentistry services in district general hospitals.

Adult↗
PubMed1989

A profile of dentists working in the general and community dental services in Scotland in 1987.

A questionnaire was sent to a list of what was considered to be all (1726) practitioners in the General Dental Service (GDS) and Community Dental Service (CDS) in Scotland. The overall response rate was 72%. A comparison of certain characteristics of the respondents with those of the entire group of dentists who were sent questionnaires suggested that the respondents comprised an acceptable cross-section. Proportionally more females worked in the CDS than in the GDS and many of the differences between the general characteristics of practitioners in the two services appeared to reflect differences which are known to exist between the career patterns of male and female dental practitioners. Most respondents (84.7%) claimed to have attended a post-graduate course within the last 5 years, although only 33.4% claimed to have attended more than one course per year. Over three-quarters of the respondents (76.0%) claimed that they belonged to a professional society, whilst 98.5% stated that they regularly read a professional journal or practice newspaper of some description.

Community Dentistry↗
PubMed1998

Dental insurance and the periodontal patient.

Approximately one-half of the United States population is covered by a dental benefit plan. One-fifth of that group is covered under various types of managed care contracts, and this number is said to be increasing by 15% to 20% per year. However, dentists report that these plans have not had a major impact upon their practices. Only 6% of patients were covered by them, and only 2% of gross receipts were derived from them. Periodontists surveyed were divided in their opinions about how managed care has affected their practices. This paper discusses these changes, particularly with regard to income, referral patterns, treatment decisions, and ethical and legal liability.

Decision Making↗
PubMed1991

A new approach to quantify cardiovascular response in dentistry.

Essential hypertension, which is common in dentists, has been attributed to mental stress but the importance of working conditions has not been evaluated. The pressor and forearm circulatory response to correct and incorrect working position during dental practice has been evaluated in 10 normotensive dentists and compared with the effects of mental stress. Mental stress elicited a significant increase in blood pressure not observed during correct dental practice despite a comparable forearm vasodilatation during both tests. Conversely incorrect working position, significantly raised blood pressure to an extent comparable to what observed during mental stress but with only a transitory and rapidly abolished forearm vasodilatation. The recordings of blood pressure or peripheral hemodynamic changes per se did not allow to discriminate between a specific response to mental stress and dental practice which, were clearly differentiated by the analysis of combined pressor and hemodynamic measurements. We conclude that odontoiatric practice carried out in an incorrect working position is able to elicit either an increase in blood pressure or abnormalities in peripheral vascular response which may contribute to the high occurrence of systemic hypertension in dentists. The evaluation of peripheral hemodynamic profile during working conditions seems to provide a useful method for a better understanding of the pattern of cardiovascular involvement in dentistry.

Adult↗
PubMed1997

Nonresponse bias in a national study of dentists' infection control practices and attitudes related to HIV.

The aim was to investigate late response and nonresponse bias in a survey related to HIV and infection control. Questionnaires with ID numbers were mailed to a stratified random sample of dentists in Canada with additional mailings 4 and 7 weeks later (n = 6444). We compared responses received after < 4 weeks, 4-7 weeks, > 7 weeks. Extrapolation was used to estimate nonresponse bias. Univariate analyses showed significant differences between responses received < 4 weeks after initial mailing and those received later for items on sociodemographics, knowledge, infection control practices and attitudes: late responders were more likely to report that they would refuse to treat any patients with HIV (P < 0.01). Multiple logistic regression indicated that the best predictors of responses received > or = 4 weeks were disagreement that HBV is more infectious than HIV (OR = 1.7); unwillingness to attend a dentist who treats HIV/AIDS patients (OR = 1.3); incorrect perception of the risk of HIV infection after an HIV-contaminated needlestick injury (OR = 1.2); and sometimes or never heat-sterilizing handpieces after each patient (OR = 1.2). Extrapolation indicated that the percentage of all respondents who reported refusal to treat (15.2%) would have been 17.1% if a 100% response rate had been obtained. We found significant evidence of late response and nonresponse bias primarily in knowledge and fears related to HIV infectivity; however, the impact on the final results was small and we concluded that additional follow-up to improve response rates would not be worthwhile.

Acquired Immunodeficiency Syndrome↗
PubMed1979

The supply of dental manpower in the United States.

This description of the supply of dental services in the United States addresses the number, kind, distribution, and training of dentists and dental auxiliaries, and the organizational factors that affect the production of dental services. Beginning with a brief historical review, the paper gives a general overview of the different types of dental personnel including the dentist, dental hygienist, dental assistant, and laboratory technician. The discussion of these categories of providers includes consideration of manpower planning as it has evolved over the past two decades, National manpower legislation is mentioned first as a reaction to the projected dentist shortage and then in response to the issues of geographic maldistribution and the effects of specialization. The second section of the paper discusses the dynamics of the dental care market. The distribution of the supply of services is identified and related to patterns of utilization and productivity. These factors are considered to be part of the set of dynamic relationships that help explain the current manpower problems of geographic and specialty maldistribution. A concluding section superficially discusses policy implications regarding the potential for increasing supply by: (1) increasing the number of dentists, (2) increasing the numbers and functions of auxiliaries, (3) increasing practice efficiency through group practice, and (4) reducing the restrictions that result from current state dental practice acts.

Dental Assistants↗
PubMed1994

Utilization of dental auxiliaries in private dental surgeries in Kenya.

This study was done to determine the nature of utilization of dental auxiliaries and medical emergencies in private dental surgeries in Kenya. A self administering questionnaire with pre-paid postage was mailed to 138 dentists. 27.5% responded. 81.6% used dental auxiliaries and the main reason was to improve efficiency in managing patients. 93.5% of the auxiliaries were on job trained secondary school graduates. 63.2% of the respondents delegated duties which were mainly non-clinical. 26.3% did not delegate any duties. In a descending order, the reasons for non delegation were: that it would be risky to patients, not allowed by law, they did not find it necessary and that auxiliaries were not held responsible if something went wrong. The main duties delegated to the auxiliaries were cleaning of instruments and sterilization, mixing of restorative materials and preparing amalgam. Delegation was done primarily based on auxiliaries capability to perform the procedure and meet the set standards. 57.9% indicated that they rarely encountered medical emergencies. Syncope was the commonest emergency encountered. 72.7% indicated that auxiliaries could not handle medical emergencies because they were not trained. It is concluded that most dentists did not delegate clinical duties to dental auxiliaries and medical emergencies were rare.

Adult↗